Modeling the 3D coronary tree for labeling purposes

Coronary artery diseases are usually revealed using X-ray angiographies. Such images are complex to analyze because they provide a 2D projection of a 3D object. Medical diagnosis suffers from inter- and intra-clinician variability. Therefore, reliable software for the 3D reconstruction and labeling of the coronary tree is strongly desired. It requires the matching of the vessels in the different available angiograms, and an approach which identifies the arteries by their anatomical names is a way to solve this difficult problem. This paper focuses on the automatic labeling of the left coronary tree in X-ray angiography. Our approach is based on a 3D topological model, built from the 3D anthropomorphic phantom, Coronix. The phantom is projected under different angles of view to provide a data base of 2D topological models. On the other hand, the vessel skeleton is extracted from the patient's angiogram. The algorithm compares the skeleton with the 2D topological model which has the most similar vascular net shape. The method performs in a hierarchical manner, first labeling the main artery, then the sub-branches. It handles inter-individual anatomical variations, segmentation errors and image ambiguities. We tested the method on standard angiograms of Coronix and on clinical examinations of nine patients. We demonstrated successful scores of 90% correct labeling for the main arteries and 60% for the sub-branches. The method appears to be particularly efficient for the arteries in focus. It is therefore a very promising tool for the automatic 3D reconstruction of the coronary tree from monoplane temporal angiographic clinical sequences.